Total anomalous pulmonary venous connection (TAPVC)is one of a few congenital heart diseases which need emergency surgical correction, but its high perioperative mortality remains a dilemma for its surgical correction. In recent years, increasing studies have achieved a great progress regarding risk factors of surgical mortality of TAPVC. Surgical era, anatomic classification, younger age, low body weight, long cardiopulmonary bypass time and pulmonary venous obstruction have been generally considered important risk factors of surgical mortality of TAPVC. This review focuses on domestic and international research progress of risk factors of surgical mortality of TAPVC in recent years in order to further understand their mechanisms, reduce surgical mortality as much as possible, and improve clinical outcomes.
Objective To therapy the atrial septal defect(ASD) much more better, comparative study of clinical outcomes in surgical treatment of ASD to other three minimally invasive procedures was performed. Methods From June 2007 to March2008, 652 ASD patients had undergone surgery（n=301）, transcatheter closure (n=274), openchest Hybrid closure(n=50) and without tracheal intubation Hybrid closure (n=27) of ASD. Patients were and divided into four groups according to the different procedures. Retrospectively we compared the data of patient’s age, hospital stay, trauma, cost of hospitalization, blood transfusion, anesthesia, tracheal intubation and postoperative fellowup. Results Median age and weight of openchest Hybrid and without tracheal intubation Hybrid groups were significantly less than those of the other two groups (Plt;0.01). The achievement ratio of four groups were 100.0％,97.2％,92.6％,100.0％. There was statistically difference in the achievement ratio of four groups (Plt;0.01). [CM(158.5mm]Median hospital stay and cost of blood transfusion of transcatheter closure and without tracheal intubation Hybrid groups were significantly less than other two groups (Plt;0.01). The mean cost of hospitalization in four groups were 24 802.90±360.96￥，25 095.07±437.13￥，24 856.77±445.87￥，24 853.56±673.99￥ respectively. There was no statistically difference in the cost of hospitalization(Pgt;0.05). All patients were recovered and discharged without eventuality. The mean followup time were 4.64±0.32 month，4.57±0.31 month，4.49±0.28 month，4.62±0.31 month. There was no statistically difference in the followup time (Pgt;0.05). The complication rate of postoperative incision were 3.32％，0.47％，6.00％，0.00％. The transcatheter closure and without tracheal intubation Hybrid groups were significantly less than other two groups (Plt;0.01). Conclusions The mean cost of hospitalization in four procedure were almost the same. The ability to close any ASD regardless of its size, location or patient’s age remains an important advantage of surgery. Transcatheter closure of ASD has the advantage of less complications. But there are limitationsto lowerweight and infant patients. OpenChest Hybrid closure offers a valuable and complementary operative approach for any age patients. Without extracorporeal circulation, it reduces trauma significantly but it always has few surgery injury. Without tracheal intubation Hybrid closure without tracheal intubation can be used for patients of any age. The cost of hospitalization is not higher than surgical treatment and transcatheter closure. The success of procedure is high and the incidence of postoperative complications is lower. It is an ideal treatment to infant ASD patients especially to lowerweight and younger infant patients.
Objective To introduce a modified REV procedure of complicated transposition of the great arteries （TGA） or double outlet right ventricle （DORV） which was combined with ventrieular septal defect （VSD） and pulmonary valve stenosis（PS）. Methods From Sep. 2005 to Feb. 2006, 3 children with complicated transposition of the great arteries underwent a modified REV operation. This modified REV operation was designed on the basis of classical REV procedure to preserve the native pulmonary artery valve and its function. Results Two patients recovered uneventfully but one died after extraeorporeal membrane oxygenator （ECMO） treatment. After 4 and 1 months follow-up respectively, the discharged 2 patients were asymptomatie and the eehoeardiography revealed that the pressure gradient between left ventrieular-main pulmonary were estimated to be 15 and 5mmHg. Conclusion This modified REV operation for preservation of pulmonary artery valve is an ideal procedure to complicated transposition of the great arteries. Advantages and disadvantages of this modified REV procedure were discussed.
Objective To analyze pathologic features and surgical procedures for patients with unroofed coronary sinus syndrome (UCSS) associated with endocardial cushion defect (ECD). Methods The clinical data of 44 patients with UCSS and ECD from May 1998 to July 2016 were retrospectively reviewed. There were 18 males and 26 females with a mean age of 10.4±12.1 years (range: 5.0 months to 44.0 years) and mean weight of 25.2±20.9 kg (range 5.2-80.0 kg). According to the Kirklin and Barratt-Boyes classification, 28 patients were categorized into type Ⅰ, 5 typeⅡ , 4 type Ⅲ and 7 type Ⅳ. Among them 25 patients suffered partial ECD, 10 complete ECD, 9 transitional ECD, and 27 were associated with single atrium, 34 involved persistent left superior vena cava (PLSVC), and in 27 of the 34 patients PLSVC directly drained into the left atrium (LA). Among the 44 patients, 1 patient associated with complex anomalies underwent palliative operation, and other cardiac malformations were corrected simultaneously by surgical correction. PLSVC was ligated in 2 patients, and the intracardiac tunnels or baffles to drain PLSVC to right atrium (RA) were reconstructed in 25 patients. The associated cardiac lesions were corrected concomitantly. Results In-hospital death occurred in 2 patients, among whom 1 died of low cardiac output syndrome on postoperative day 8 and the other pulmonary infection on postoperative day 21. Thirty-one were followed up from 1 month to 10 years, and there was no death or severe complications. Conclusion When ECD is associated with PLSVC and a single atrium, UCSS may develop. Repair according to the type of UCSS is effective.
Objective To explore the feasibility of modified Bentall operation with pericardium lining in patients with aortic root dilatation (ARD). MethodsThis study was a retrospective study. From January 2023 to February 2024, the patients were selected for treatment in Suzhou Municipal Hospital, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University and Guangyuan First People's Hospital. The preoperative clinical and imaging evaluation data (including echocardiography and CT of aortic root and whole aorta), the data of coronary intervention, the surgical effect and the postoperative follow-up results were collected. All patients were treated with improved Bentall operation with "pericardium lining": the aortic valve was replaced, and the autologous pericardium was divided into three parts according to the circumferential diameter of the aortic valve ring measured by the valve measuring instrument, and sutured with to the valve ring respectively; two pericardial slices "opened the window" and anastomosed anastomosis with the left and right coronary artery openings; the pericardial piece was sutured with to the aortic sinus wall to form a whole, narrowing the sinus. Artificial blood vessels were used to suture the proximal and distal aorta without aortic root-right atrial shunt. Results Five patients were collected, aged from 37 to 68 years. The average STS risk score was 3.4%. The preoperative ascending aorta diameter was (56.4±16.6) mm, the preoperative left ventricular end diastolic diameter was (62.0±9.0) mm, and the preoperative left ventricular ejection fraction was (56.0±8.0%. The time of aortic occlusion was (129.6±50.4) min, and the time of cardiopulmonary bypass was (188.2±113.8) min. Echocardiography showed that the diameter of ascending the ascending aorta was (30.2±4.8) mm, the end diastolic diameter of left the left ventricle was (48.2±8.8) mm, and the left ventricular ejection fraction was 51.4%±9.6%. The operation was successfully completed, and the immediate effect was satisfactory. There were no complications during the operation. There was no death and reoperation no reoperation during the follow-up period. Conclusion For patients with ARD, the preliminary results of improved Bentall operation with "pericardium lining" are satisfactory and the technique is feasible.